WEBVTT 00:00:10.000 --> 00:00:13.770 position:50% align:middle - [Alison] The International Nurse Regulator Collaborative's Mobility Project. 00:00:13.770 --> 00:00:16.990 position:50% align:middle How similar are expectations and processes? 00:00:16.990 --> 00:00:20.001 position:50% align:middle So, I'm here today to talk to you about this project. 00:00:21.440 --> 00:00:27.100 position:50% align:middle Formed in 2011, the International Nurse Regulator Collaborative, or INRC, 00:00:27.100 --> 00:00:33.730 position:50% align:middle is a collaboration of nine jurisdictions around the world, Australia, British Columbia and Ontario 00:00:33.730 --> 00:00:39.960 position:50% align:middle from Canada, Ireland, New Zealand, Singapore, Spain, the United Kingdom, and the United States, 00:00:39.960 --> 00:00:42.301 position:50% align:middle which is represented by NCSBN. 00:00:42.301 --> 00:00:47.530 position:50% align:middle The INRC provides a forum for collaboration between the members. 00:00:47.530 --> 00:00:53.760 position:50% align:middle It focuses on the changing and evolving world of regulation and the impacts created by an increasingly 00:00:53.760 --> 00:00:56.220 position:50% align:middle connected and mobile world. 00:00:56.220 --> 00:01:01.430 position:50% align:middle Its aim is to be proactive and to stay ahead of impending changes. 00:01:01.430 --> 00:01:08.380 position:50% align:middle The forum's purpose is to promote international regulatory research, share knowledge and ideas, 00:01:08.380 --> 00:01:13.765 position:50% align:middle and work together to influence policy to protect the health and safety of the public. 00:01:15.439 --> 00:01:22.990 position:50% align:middle In 2018, the INRC members decided to undertake a research project to explore whether it would be 00:01:22.990 --> 00:01:29.180 position:50% align:middle possible to recognize each other's licensure or registration across the member jurisdictions. 00:01:29.180 --> 00:01:38.290 position:50% align:middle The purpose of this would be to reduce barriers and to allow for more easy mobility between the members. 00:01:38.290 --> 00:01:43.640 position:50% align:middle They undertook this project because, over the past 7 years of working together, 00:01:43.640 --> 00:01:50.470 position:50% align:middle they had come to recognize that their health-care systems, the roles of the nurses that they regulated, 00:01:50.470 --> 00:01:55.920 position:50% align:middle and their standards for licensure or registration were reasonably similar. 00:01:55.920 --> 00:01:58.320 position:50% align:middle So, by way of clarification, the U.S. 00:01:58.320 --> 00:02:05.150 position:50% align:middle uses the term licensure for its regulatory processes, while the other INRC countries use 00:02:05.150 --> 00:02:07.440 position:50% align:middle the term "registration." 00:02:07.440 --> 00:02:13.020 position:50% align:middle This is just one example of the use of different terminology for similar processes 00:02:13.020 --> 00:02:14.840 position:50% align:middle within the INRC jurisdictions. 00:02:16.094 --> 00:02:19.140 position:50% align:middle So, now the Mobility Project. 00:02:19.140 --> 00:02:22.930 position:50% align:middle The Mobility Project currently has three phases. 00:02:22.930 --> 00:02:29.380 position:50% align:middle Phase 1 was the initial feasibility study, which investigated whether it was possible and 00:02:29.380 --> 00:02:36.100 position:50% align:middle desirable to develop some type of a regulatory mechanism that could support the mobility of nurses 00:02:36.100 --> 00:02:38.740 position:50% align:middle across the jurisdictions. 00:02:38.740 --> 00:02:47.210 position:50% align:middle Phase 2 was the in-depth review of the consistency of the licensure or registration standards that underpin 00:02:47.210 --> 00:02:50.510 position:50% align:middle nursing practice in each jurisdiction. 00:02:50.510 --> 00:02:56.700 position:50% align:middle And Phase 3 is the review of the operational processes used in each jurisdiction, 00:02:56.700 --> 00:02:59.790 position:50% align:middle and this phase is currently underway. 00:02:59.790 --> 00:03:06.740 position:50% align:middle The findings from Phases 1 and 2 comprise two large and detailed reports. 00:03:06.740 --> 00:03:11.020 position:50% align:middle In this presentation, I will try to give you an overview of the main findings 00:03:11.020 --> 00:03:12.109 position:50% align:middle of this work. 00:03:13.730 --> 00:03:21.510 position:50% align:middle So, Phase 1 explored whether trans-jurisdictional mobility was potentially feasible and what would need 00:03:21.510 --> 00:03:24.840 position:50% align:middle to be in place for this to happen. 00:03:24.840 --> 00:03:32.460 position:50% align:middle So, this phase included a literature review, a high-level review of the jurisdictional procedures 00:03:32.460 --> 00:03:39.310 position:50% align:middle and processes, and the interviews with senior regulatory executives in each of the jurisdictions. 00:03:39.310 --> 00:03:46.010 position:50% align:middle All types of regulated nurses were included in this phase so we had practical and vocational nurses or 00:03:46.010 --> 00:03:49.540 position:50% align:middle enrolled nurses, as they are known in Australia, New Zealand and Singapore, 00:03:49.540 --> 00:03:57.120 position:50% align:middle and all the different types of registered nurses, including psychiatric and mental-health nurses and 00:03:57.120 --> 00:04:01.270 position:50% align:middle child-learning-disability nurses from Ireland and the UK. 00:04:01.270 --> 00:04:07.890 position:50% align:middle And nurse practitioners in all their different designations, from Australia, British Columbia, 00:04:07.890 --> 00:04:12.610 position:50% align:middle Ireland, Ontario, New Zealand, Singapore, Spain, and the U.S. 00:04:12.610 --> 00:04:17.480 position:50% align:middle The UK does not regulate nurse practitioners. 00:04:17.480 --> 00:04:25.770 position:50% align:middle And this phase examined at a high level all the factors underpinning registration or licensure. 00:04:25.770 --> 00:04:30.180 position:50% align:middle Now, these factors, included current global issues, the legal, educational, 00:04:30.180 --> 00:04:37.200 position:50% align:middle and disciplinary frameworks that the regulators use, their current information, communication, 00:04:37.200 --> 00:04:42.160 position:50% align:middle and technology capacity, it reviewed the basics of the standards and 00:04:42.160 --> 00:04:47.820 position:50% align:middle requirements and processes for licensure and registration that were used in each jurisdiction, 00:04:47.820 --> 00:04:52.612 position:50% align:middle and then it identified the commonalities and differences between the jurisdictions. 00:04:55.040 --> 00:04:56.930 position:50% align:middle This was a big undertaking. 00:04:56.930 --> 00:05:00.180 position:50% align:middle So, be prepared, there's a lot that we're going to briefly touch on in these findings. 00:05:00.180 --> 00:05:03.690 position:50% align:middle Firstly, the legal frameworks. 00:05:03.690 --> 00:05:10.840 position:50% align:middle All the INRC jurisdictions have their eligibility for licensure or registration established in either 00:05:10.840 --> 00:05:16.280 position:50% align:middle legislation or regulator-enacted bylaws standards or rules. 00:05:16.280 --> 00:05:23.070 position:50% align:middle The only way that these requirements can be waived is through a government-to-government mutual 00:05:23.070 --> 00:05:27.260 position:50% align:middle recognition agreement, of which there are three that directly impact 00:05:27.260 --> 00:05:28.980 position:50% align:middle the INRC jurisdictions. 00:05:28.980 --> 00:05:34.680 position:50% align:middle We have the Trans-Tasman Agreement between Australia and New Zealand. 00:05:34.680 --> 00:05:39.410 position:50% align:middle There's the Canadian Free Trade Agreement, which affects British Columbia and Ontario. 00:05:39.410 --> 00:05:45.600 position:50% align:middle And then there's the European Mobility Directives, which affect Ireland, Spain, and the UK. 00:05:45.600 --> 00:05:52.620 position:50% align:middle So, for the purposes of this presentation, the EU countries are effectively Ireland, Spain, 00:05:52.620 --> 00:05:54.540 position:50% align:middle and the UK. 00:05:54.540 --> 00:06:02.160 position:50% align:middle Now, the UK has left the EU through Brexit, but the UK regulator, the Nursing and Midwifery Council, 00:06:02.160 --> 00:06:10.780 position:50% align:middle has been required by government legislation to keep in place, affect all of the EU mobility arrangements. 00:06:10.780 --> 00:06:14.830 position:50% align:middle And, also, when referring to the U.S., this will be the findings from the majority 00:06:14.830 --> 00:06:16.240 position:50% align:middle of the states. 00:06:16.240 --> 00:06:21.070 position:50% align:middle While it is acknowledged that there may be a few states, there are an exception to a finding. 00:06:22.900 --> 00:06:29.110 position:50% align:middle So, all jurisdictions have a legal framework that requires an educational qualification, 00:06:29.110 --> 00:06:33.070 position:50% align:middle language proficiency, and good character in order to obtain 00:06:33.070 --> 00:06:35.560 position:50% align:middle licensure or registration. 00:06:35.560 --> 00:06:42.360 position:50% align:middle And seven of the nine jurisdictions also have a requirement for recency of practice. 00:06:42.360 --> 00:06:49.320 position:50% align:middle Some jurisdictions have specified legal requirements for an external assessment or examination prior 00:06:49.320 --> 00:06:54.130 position:50% align:middle to licensure or registration, while for others this is at the discretion 00:06:54.130 --> 00:06:56.170 position:50% align:middle of the regulator. 00:06:56.170 --> 00:07:03.860 position:50% align:middle And all the jurisdictions, except Spain, allow the regulator to determine the acceptability 00:07:03.860 --> 00:07:06.510 position:50% align:middle of the educational qualification. 00:07:06.510 --> 00:07:12.339 position:50% align:middle In Spain, only the government ministry responsible for universities can do this. 00:07:13.830 --> 00:07:20.110 position:50% align:middle So, from the information that was obtained, it did not appear that there were any significant 00:07:20.110 --> 00:07:26.730 position:50% align:middle impediments within the legal frameworks of the jurisdictions that would prevent the development 00:07:26.730 --> 00:07:33.320 position:50% align:middle of some kind of a pathway that could either streamline the process or allow for recognition of other 00:07:33.320 --> 00:07:37.130 position:50% align:middle INRC regulatory credentials. 00:07:37.130 --> 00:07:43.700 position:50% align:middle So, all the jurisdictions have a scope of nursing practice that's guided by law, education, 00:07:43.700 --> 00:07:46.280 position:50% align:middle and individual competence. 00:07:46.280 --> 00:07:52.920 position:50% align:middle In six of the nine jurisdictions, the scope of practice is specified in legal regulations 00:07:52.920 --> 00:07:56.050 position:50% align:middle determined by the government and the regulator. 00:07:56.050 --> 00:07:59.880 position:50% align:middle While, in the other three jurisdictions, it is largely determined by the employer 00:07:59.880 --> 00:08:01.190 position:50% align:middle and the registrant. 00:08:01.190 --> 00:08:08.760 position:50% align:middle Some jurisdictions have specific lists of controlled or restricted activities, 00:08:08.760 --> 00:08:12.597 position:50% align:middle while others use flow charts and guidance documents. 00:08:14.250 --> 00:08:20.510 position:50% align:middle All jurisdictions have documentation that addresses the expectations at entry-to-practice, 00:08:20.510 --> 00:08:25.960 position:50% align:middle the standards for nursing practice and professional behavior, and the standards for accrediting or 00:08:25.960 --> 00:08:29.280 position:50% align:middle approving a nursing education program. 00:08:29.280 --> 00:08:35.520 position:50% align:middle In all jurisdictions, except Spain, the regulator has the ultimate responsibility 00:08:35.520 --> 00:08:39.290 position:50% align:middle to accredit or approve a nursing education program. 00:08:39.290 --> 00:08:46.800 position:50% align:middle In Spain, this ultimate responsibility lies with the government ministry responsible for universities. 00:08:46.800 --> 00:08:52.770 position:50% align:middle However, in all jurisdictions, the processes and steps that are followed to accredit 00:08:52.770 --> 00:08:56.080 position:50% align:middle or approve an educational program are similar. 00:08:56.080 --> 00:09:02.010 position:50% align:middle In all jurisdictions, the regulator or its approved disciplinary council are 00:09:02.010 --> 00:09:08.600 position:50% align:middle responsible for addressing complaints, fitness to practice, and professional discipline. 00:09:08.600 --> 00:09:13.890 position:50% align:middle Now complaints can address conduct, competence, and health concerns. 00:09:13.890 --> 00:09:21.720 position:50% align:middle And all jurisdictions have a similar process to review, investigate, and determine outcomes. 00:09:21.720 --> 00:09:26.080 position:50% align:middle In all jurisdictions, the registrant can have conditions placed 00:09:26.080 --> 00:09:31.690 position:50% align:middle on their practice, be suspended from practice, or have their license or registration revoked. 00:09:31.690 --> 00:09:34.970 position:50% align:middle And this is noted on a public register. 00:09:34.970 --> 00:09:41.140 position:50% align:middle This was one of the areas where it was noted that there was a significant degree of variation in the 00:09:41.140 --> 00:09:46.020 position:50% align:middle terminology used across the jurisdictions. 00:09:46.020 --> 00:09:53.030 position:50% align:middle "Grandparenting nurses," a term that probably many of you are not familiar with at all. 00:09:53.030 --> 00:10:00.715 position:50% align:middle Grandparenting refers to the requirements for licensure or registration changing over time and whether the 00:10:00.715 --> 00:10:08.280 position:50% align:middle registrant having gained full licensure or registration is required to upgrade to the new qualification 00:10:08.280 --> 00:10:12.250 position:50% align:middle to maintain their licensure or registration. 00:10:12.250 --> 00:10:18.740 position:50% align:middle In most cases, this change refers to the initial educational qualification requirement being raised 00:10:18.740 --> 00:10:22.230 position:50% align:middle to the level of a university degree. 00:10:22.230 --> 00:10:29.880 position:50% align:middle So, all INRC jurisdictions, except Spain and the U.S., have grandparented nurses and have not required them 00:10:29.880 --> 00:10:34.600 position:50% align:middle to upgrade to their new level of qualifications. 00:10:34.600 --> 00:10:40.400 position:50% align:middle Obviously, the number of these grandparented nurses is decreasing in all the jurisdictions, 00:10:40.400 --> 00:10:44.110 position:50% align:middle but a significant number of them still remain. 00:10:44.110 --> 00:10:51.020 position:50% align:middle These registrants may only have a hospital-based certificate or a diploma, but there is no regulatory 00:10:51.020 --> 00:10:53.583 position:50% align:middle restrictions being placed on their practice. 00:10:55.960 --> 00:11:03.170 position:50% align:middle In Spain, in 1977, it was made mandatory for all RNs to have a university degree, 00:11:03.170 --> 00:11:10.060 position:50% align:middle and all nurses were required to upgrade to this level to maintain their registration. 00:11:10.060 --> 00:11:14.270 position:50% align:middle In the United States, no state has a requirement for a university degree 00:11:14.270 --> 00:11:22.660 position:50% align:middle for initial licensure and diplomas, associate degrees, bachelor, and master's degrees are all accepted. 00:11:22.660 --> 00:11:26.510 position:50% align:middle Information, communication, and technology. 00:11:26.510 --> 00:11:35.050 position:50% align:middle In order for there to be trans-jurisdictional mobility, there must be real-time sharing of registrant data. 00:11:35.050 --> 00:11:41.350 position:50% align:middle This may require data-sharing arrangements between the jurisdictions, and there must also be privacy and 00:11:41.350 --> 00:11:45.070 position:50% align:middle security mechanisms put in place. 00:11:45.070 --> 00:11:51.600 position:50% align:middle Currently, all the jurisdictions have their registrant databases and processes digitalized and some are 00:11:51.600 --> 00:11:55.190 position:50% align:middle using cloud-based platforms. 00:11:55.190 --> 00:11:59.200 position:50% align:middle Currently, there is some electronic data-sharing arrangements that are in place 00:11:59.200 --> 00:12:02.180 position:50% align:middle within the INRC jurisdictions. 00:12:02.180 --> 00:12:04.400 position:50% align:middle I'm sure most of you are familiar with the U.S. 00:12:04.400 --> 00:12:07.780 position:50% align:middle internal data-sharing system of nurses. 00:12:07.780 --> 00:12:15.140 position:50% align:middle Australia also has a Practitioner Information Exchange portal where they share information internally 00:12:15.140 --> 00:12:20.150 position:50% align:middle with other organizations and with some international organizations. 00:12:20.150 --> 00:12:27.650 position:50% align:middle And the EU has their Internal Market Information System which provides for sharing of registrant data and 00:12:27.650 --> 00:12:32.490 position:50% align:middle disciplinary information between Ireland and Spain. 00:12:32.490 --> 00:12:39.230 position:50% align:middle Post-Brexit, the UK has a sharing agreement with the EU member states but it is much more restrictive than it 00:12:39.230 --> 00:12:40.936 position:50% align:middle was under the previous system. 00:12:42.370 --> 00:12:47.480 position:50% align:middle BC, Ontario, New Zealand, and Singapore currently do not share 00:12:47.480 --> 00:12:49.670 position:50% align:middle any registrant data. 00:12:49.670 --> 00:12:55.930 position:50% align:middle However, BC, Ontario, and NCSBN are currently working on a cloud-based system 00:12:55.930 --> 00:12:58.550 position:50% align:middle similar to Nursys for Canada. 00:12:58.550 --> 00:13:05.330 position:50% align:middle Initially, this will only include British Columbia and Ontario, but other provinces are expected to join. 00:13:08.720 --> 00:13:15.760 position:50% align:middle The next part of this phase looked at the most common elements required for licensure or registration and how 00:13:15.760 --> 00:13:19.765 position:50% align:middle consistent these elements were across the jurisdictions. 00:13:21.130 --> 00:13:28.000 position:50% align:middle So, in the area of establishing identity, all jurisdictions required some form 00:13:28.000 --> 00:13:34.960 position:50% align:middle of government-issued identification to establish identity and no jurisdiction required mandatory 00:13:34.960 --> 00:13:42.570 position:50% align:middle in-person attendance for domestic applicants, although some of them do for international applicants. 00:13:42.570 --> 00:13:48.920 position:50% align:middle For international applicants, Canada and New Zealand require CGFNS 00:13:48.920 --> 00:13:51.420 position:50% align:middle to verify all documentation. 00:13:51.420 --> 00:13:52.470 position:50% align:middle And the U.S. 00:13:52.470 --> 00:13:57.770 position:50% align:middle requires one of their authorized credential evaluation organizations to do this. 00:14:00.045 --> 00:14:02.220 position:50% align:middle Language proficiency. 00:14:02.220 --> 00:14:10.150 position:50% align:middle All the INRC jurisdictions have language-proficiency requirements for either English, French, or Spanish. 00:14:10.150 --> 00:14:16.260 position:50% align:middle English is the most commonly required language with seven of the nine jurisdictions requiring it, 00:14:16.260 --> 00:14:20.320 position:50% align:middle and six of the...sorry, and eight of the nine having a minimum proficiency 00:14:20.320 --> 00:14:22.360 position:50% align:middle standard for it. 00:14:22.360 --> 00:14:29.960 position:50% align:middle Ontario has a bilingual language policy accepting either English or French proficiency, while Spain, 00:14:29.960 --> 00:14:32.849 position:50% align:middle obviously, has a requirement for Spanish. 00:14:34.940 --> 00:14:41.430 position:50% align:middle For jurisdictions with English requirements, all applicants are required to demonstrate some form 00:14:41.430 --> 00:14:44.400 position:50% align:middle of language-proficiency assessment. 00:14:44.400 --> 00:14:50.100 position:50% align:middle This can either be through their educational background or previous practice experience or 00:14:50.100 --> 00:14:54.080 position:50% align:middle through an English-language proficiency test. 00:14:54.080 --> 00:15:00.530 position:50% align:middle The IELTS language test is the only test accepted by all jurisdictions that use an external test. 00:15:00.530 --> 00:15:05.066 position:50% align:middle The most commonly accepted minimum overall score 00:15:05.066 --> 00:15:11.780 position:50% align:middle is 7.0, but there are variations across all jurisdictions and in all sections of this test. 00:15:14.646 --> 00:15:21.790 position:50% align:middle In the area of educational preparation, all jurisdictions have specified requirements for their 00:15:21.790 --> 00:15:29.230 position:50% align:middle domestic programs, which are based on their practice standards and requirements for entry-to-practice. 00:15:29.230 --> 00:15:37.060 position:50% align:middle In some cases, these include minimum clinical hours and they have specified stated content elements which must 00:15:37.060 --> 00:15:39.013 position:50% align:middle be included in their curriculums. 00:15:40.810 --> 00:15:49.040 position:50% align:middle These expectations for domestic programs are then used to measure equivalency for international applicants. 00:15:49.040 --> 00:15:56.630 position:50% align:middle All INRC jurisdictions, except Ontario, Spain, and the U.S., have, at some time, 00:15:56.630 --> 00:16:01.710 position:50% align:middle offered specialized entry-to-practice RN education. 00:16:01.710 --> 00:16:09.730 position:50% align:middle Most commonly this was in the areas of mental health or psychiatry, children, or learning disabilities. 00:16:09.730 --> 00:16:16.870 position:50% align:middle British Columbia, Ireland, Singapore, and the UK continue to offer some or all of these 00:16:16.870 --> 00:16:20.420 position:50% align:middle specialized educational programs. 00:16:20.420 --> 00:16:27.268 position:50% align:middle RNs with this specialized education are registered in separate categories on the jurisdictional register. 00:16:29.870 --> 00:16:36.020 position:50% align:middle So, most of you would be aware that passing the NCLEX examination is a requirement for licensure or 00:16:36.020 --> 00:16:41.240 position:50% align:middle registration for both domestic and international applicants in both the U.S. 00:16:41.240 --> 00:16:42.960 position:50% align:middle and Canada. 00:16:42.960 --> 00:16:50.010 position:50% align:middle New Zealand also requires their domestic graduates to successfully complete the New Zealand state final exam 00:16:50.010 --> 00:16:53.320 position:50% align:middle before being registered, but they do not require this 00:16:53.320 --> 00:16:56.210 position:50% align:middle for international applicants. 00:16:56.210 --> 00:17:02.880 position:50% align:middle Australia, Ireland, Singapore, Spain, and the UK do not require an examination for their 00:17:02.880 --> 00:17:08.320 position:50% align:middle domestic graduates but Australia, Singapore, and the UK require this for some 00:17:08.320 --> 00:17:11.380 position:50% align:middle of their international applicants. 00:17:11.380 --> 00:17:17.670 position:50% align:middle When an examination is required for international applicants, Australia uses the NCLEX, 00:17:17.670 --> 00:17:22.054 position:50% align:middle and Singapore and the UK use their own internally-developed exams. 00:17:24.210 --> 00:17:28.850 position:50% align:middle Recency of practice and continuing professional development are required by most 00:17:28.850 --> 00:17:31.770 position:50% align:middle of the INRC jurisdictions. 00:17:31.770 --> 00:17:36.490 position:50% align:middle Ireland and Spain do not have any regulatory requirements for recency of practice or 00:17:36.490 --> 00:17:39.030 position:50% align:middle continuing professional development. 00:17:39.030 --> 00:17:43.061 position:50% align:middle And, in the U.S., some states have these and some do not. 00:17:45.050 --> 00:17:50.170 position:50% align:middle British Columbia, Ontario, and the UK have more stringent requirements 00:17:50.170 --> 00:17:54.880 position:50% align:middle for continuing competence, which includes every nurse being required, 00:17:54.880 --> 00:18:01.510 position:50% align:middle on a regular basis, to obtain feedback on their practice from other professionals and they are required 00:18:01.510 --> 00:18:05.338 position:50% align:middle to create, implement, and evaluate their own learning plan. 00:18:08.600 --> 00:18:13.990 position:50% align:middle The majority of jurisdictions require a self-declaration of good character and fitness 00:18:13.990 --> 00:18:18.400 position:50% align:middle to practice for both internal...sorry, for both initial and continuing 00:18:18.400 --> 00:18:21.220 position:50% align:middle licensure or registration. 00:18:21.220 --> 00:18:25.610 position:50% align:middle This also includes disclosure of any criminal history. 00:18:25.610 --> 00:18:32.280 position:50% align:middle Half the jurisdictions require a formal criminal record check for initial licensure or registration and, 00:18:32.280 --> 00:18:38.000 position:50% align:middle in most cases, this must also include their country of residence and any country that they've lived 00:18:38.000 --> 00:18:39.584 position:50% align:middle in for more than 3 months. 00:18:40.920 --> 00:18:47.170 position:50% align:middle British Columbia undertakes a formal criminal record check on all registrants every 5 years, 00:18:47.170 --> 00:18:52.172 position:50% align:middle while Spain only requires a criminal record check if the nurse is working with children. 00:18:55.280 --> 00:19:02.050 position:50% align:middle So, nurses, moving within the INRC jurisdictions, can currently do so under either a labor mobility 00:19:02.050 --> 00:19:07.700 position:50% align:middle mutual recognition agreement or as internationally educated nurses. 00:19:07.700 --> 00:19:15.570 position:50% align:middle Australia and New Zealand have a mobility agreement, as do the EU jurisdictions, Ireland, Spain, and the UK. 00:19:15.570 --> 00:19:19.800 position:50% align:middle And Canada has its internal mobility agreement. 00:19:19.800 --> 00:19:27.610 position:50% align:middle For nurses not covered by these mobility agreements, if the receiving jurisdiction deems their education 00:19:27.610 --> 00:19:32.590 position:50% align:middle as equivalent, then they meet all the other requirements, they are usually eligible 00:19:32.590 --> 00:19:35.110 position:50% align:middle for licensure or registration. 00:19:35.110 --> 00:19:40.310 position:50% align:middle Or, in the case of Canada and the U.S., they are then able to write the NCLEX. 00:19:40.310 --> 00:19:46.660 position:50% align:middle If their education is not deemed equivalent, all jurisdictions, except Spain and the U.S., 00:19:46.660 --> 00:19:50.200 position:50% align:middle refer them to a competence assessment process. 00:19:50.200 --> 00:19:57.910 position:50% align:middle Currently, the UK refers all non-EU international nurses to their competence assessment process as there 00:19:57.910 --> 00:19:59.880 position:50% align:middle is no educational equivalency. 00:19:59.880 --> 00:20:06.830 position:50% align:middle So, as part of this feasibility study, the benefits, opportunities, risks, 00:20:06.830 --> 00:20:12.290 position:50% align:middle and challenges of recognizing each other's credentials was investigated. 00:20:12.290 --> 00:20:19.530 position:50% align:middle The identified benefits were that the process for low-risk applicants could be streamlined, 00:20:19.530 --> 00:20:25.810 position:50% align:middle it would increase the opportunities for mobility, and it would also address the concerns that have been 00:20:25.810 --> 00:20:33.600 position:50% align:middle expressed by all regulators about nurses providing telehealth across international borders. 00:20:33.600 --> 00:20:40.400 position:50% align:middle This would also provide the opportunity to come to an agreement and better align regulatory practice and 00:20:40.400 --> 00:20:44.430 position:50% align:middle educational standards across the jurisdictions. 00:20:44.430 --> 00:20:49.920 position:50% align:middle It would reduce the regulatory workload, it would help to more clearly define what nursing 00:20:49.920 --> 00:20:54.690 position:50% align:middle practice is, and it would provide increased opportunities for learning, sharing, 00:20:54.690 --> 00:20:57.557 position:50% align:middle and working together within the framework. 00:20:59.880 --> 00:21:07.210 position:50% align:middle The identified risks were this process must not result in the lowest common denominator and there must be a 00:21:07.210 --> 00:21:14.140 position:50% align:middle common standard for the expectations and assessment of internationally-educated nurses. 00:21:14.140 --> 00:21:17.530 position:50% align:middle However, there are challenges if we want to get there. 00:21:17.530 --> 00:21:22.170 position:50% align:middle We need to accept and trust each other's standards and processes. 00:21:22.170 --> 00:21:28.190 position:50% align:middle We need to figure out how to do this within each jurisdiction's legislative framework. 00:21:28.190 --> 00:21:34.200 position:50% align:middle We need a better understanding of the terminology and language used in each jurisdiction and we need to be 00:21:34.200 --> 00:21:37.400 position:50% align:middle able to share data in real time. 00:21:37.400 --> 00:21:42.230 position:50% align:middle And we need also to agree on the processes for licensure registration and the use 00:21:42.230 --> 00:21:44.052 position:50% align:middle of external assessments. 00:21:46.310 --> 00:21:53.000 position:50% align:middle So, overall, the key findings from the feasibility study were that the similarities significantly 00:21:53.000 --> 00:21:55.310 position:50% align:middle outweighed the differences. 00:21:55.310 --> 00:22:00.060 position:50% align:middle There was significant evidence, drivers, and interests to support continuing this 00:22:00.060 --> 00:22:07.240 position:50% align:middle trans-jurisdictional mobility work and making it clearly desirable to continue the project. 00:22:07.240 --> 00:22:14.210 position:50% align:middle It was also decided that all future work would be limited only to RNs with a generalized education. 00:22:14.210 --> 00:22:23.840 position:50% align:middle So, the next steps then became to undertake a more detailed review of each jurisdiction's expectations or 00:22:23.840 --> 00:22:28.390 position:50% align:middle standards for entry-to-practice, professional practice and behavior, 00:22:28.390 --> 00:22:34.320 position:50% align:middle and educational program accreditation and approval, and to start developing a language...sorry, 00:22:34.320 --> 00:22:37.508 position:50% align:middle a glossary of language used across the jurisdictions. 00:22:40.040 --> 00:22:42.830 position:50% align:middle These steps then became the focus for Phase 2. 00:22:42.830 --> 00:22:49.290 position:50% align:middle Phase 2 was the mapping of each jurisdiction's entry-to-practice requirements, 00:22:49.290 --> 00:22:55.310 position:50% align:middle professional practice and behavioral standards, and standards and processes for educational 00:22:55.310 --> 00:22:57.850 position:50% align:middle approval or accreditation. 00:22:57.850 --> 00:23:05.060 position:50% align:middle The purpose of this was to identify the level of consistency across the jurisdictions and the existence 00:23:05.060 --> 00:23:06.963 position:50% align:middle of gaps or differences. 00:23:08.639 --> 00:23:15.940 position:50% align:middle So, to do this, each jurisdiction's documentation was reviewed and then entered into one of four mapping 00:23:15.940 --> 00:23:20.690 position:50% align:middle frameworks specifically developed for this purpose. 00:23:20.690 --> 00:23:26.700 position:50% align:middle Two of these mapping frameworks were used for the entry-to-practice requirements and one each 00:23:26.700 --> 00:23:32.030 position:50% align:middle for professional practice and behavioral expectations and educational program approval. 00:23:32.030 --> 00:23:39.920 position:50% align:middle For a topic or a theme to be included in a mapping framework, it had to appear in four or 00:23:39.920 --> 00:23:43.200 position:50% align:middle more jurisdictions documentation. 00:23:43.200 --> 00:23:50.510 position:50% align:middle A review was also undertaken of the background and processes used to develop each of the jurisdictions 00:23:50.510 --> 00:23:56.109 position:50% align:middle standards and all the terminology used was entered into a developing glossary. 00:23:57.760 --> 00:24:03.000 position:50% align:middle Now, all the jurisdictional regulators, except the U.S., had specific documents that fitted 00:24:03.000 --> 00:24:04.110 position:50% align:middle into these categories. 00:24:04.110 --> 00:24:06.400 position:50% align:middle For the U.S. 00:24:06.400 --> 00:24:12.290 position:50% align:middle the NCLEX test plan and knowledge statements were used for entry-to-practice requirements. 00:24:12.290 --> 00:24:18.790 position:50% align:middle The Nurse Licensure Compact model rules and the American Nurses Association Code of Ethics were used 00:24:18.790 --> 00:24:22.390 position:50% align:middle for the professional practice and behavioral expectations. 00:24:22.390 --> 00:24:28.500 position:50% align:middle And the model rules and the new NCSBN guidelines for Nursing Education Program Approval were used 00:24:28.500 --> 00:24:30.997 position:50% align:middle for educational program expectations. 00:24:30.997 --> 00:24:34.020 position:50% align:middle So, the findings from Phase 2. 00:24:34.020 --> 00:24:40.640 position:50% align:middle While this was an extremely detailed review process, it did produce more succinct findings. 00:24:40.640 --> 00:24:42.904 position:50% align:middle So, you get a bit of a reprieve here. 00:24:44.370 --> 00:24:47.520 position:50% align:middle First, entry-to-practice expectations. 00:24:47.520 --> 00:24:53.370 position:50% align:middle Seven out of the nine jurisdictions had updated their expectations within the last five years, 00:24:53.370 --> 00:24:58.220 position:50% align:middle and six had set time frames for continuing reviews and updates. 00:24:58.220 --> 00:25:04.560 position:50% align:middle For five jurisdictions, this review period was either three or five years. 00:25:04.560 --> 00:25:11.690 position:50% align:middle And all jurisdictions had similar processes to develop their expectations, which included a literature review, 00:25:11.690 --> 00:25:16.320 position:50% align:middle consultation with stakeholders, the development of draft expectations, 00:25:16.320 --> 00:25:19.980 position:50% align:middle and then approval by the regulator's board or council. 00:25:19.980 --> 00:25:26.600 position:50% align:middle Three jurisdictions used an online survey to validate their expectations with practicing RNs prior 00:25:26.600 --> 00:25:27.730 position:50% align:middle to the final approval. 00:25:29.861 --> 00:25:34.460 position:50% align:middle So, these are the categories that were used in the first mapping framework, 00:25:34.460 --> 00:25:37.740 position:50% align:middle content expectations for entry to practice. 00:25:37.740 --> 00:25:44.380 position:50% align:middle There are 11 categories in this framework, with the ones noted in lighter blue being subcategories 00:25:44.380 --> 00:25:49.060 position:50% align:middle of a main category, in this case, management of care. 00:25:49.060 --> 00:25:55.170 position:50% align:middle The findings from the category "Population and context of practice" were almost exactly the same 00:25:55.170 --> 00:25:59.800 position:50% align:middle in all jurisdictions, with the exception that two jurisdictions did not 00:25:59.800 --> 00:26:05.750 position:50% align:middle specifically state maternity or obstetric nursing care as a requirement. 00:26:05.750 --> 00:26:12.470 position:50% align:middle Across the other 10 categories in this framework, 82 subcategories were identified, 00:26:12.470 --> 00:26:16.490 position:50% align:middle far too many to comment on in this presentation. 00:26:16.490 --> 00:26:24.290 position:50% align:middle However, this table shows you the level of consistency at the category level across the jurisdictions. 00:26:24.290 --> 00:26:30.400 position:50% align:middle For a jurisdiction to obtain a check mark in a category, every sub-category in that category had to be 00:26:30.400 --> 00:26:34.850 position:50% align:middle included in their documented expectations. 00:26:34.850 --> 00:26:40.730 position:50% align:middle As you can see, overall, there was a high level of consistency with 89% of the 00:26:40.730 --> 00:26:44.580 position:50% align:middle categories being addressed across the jurisdictions. 00:26:44.580 --> 00:26:51.280 position:50% align:middle British Columbia and Ontario addressed all the subcategories in every category of the framework. 00:26:51.280 --> 00:26:56.480 position:50% align:middle And most of the gaps occurred in two categories, promoting health and well-being, 00:26:56.480 --> 00:26:59.000 position:50% align:middle and leadership management and coordination. 00:26:59.000 --> 00:27:06.660 position:50% align:middle Where there were gaps, in most cases, the jurisdiction had only one sub-category missing 00:27:06.660 --> 00:27:08.734 position:50% align:middle in that particular category. 00:27:10.590 --> 00:27:14.970 position:50% align:middle So, this is the second mapping framework that was used in the entry-to-practice area. 00:27:14.970 --> 00:27:18.950 position:50% align:middle And this relates to expected knowledge and skills. 00:27:18.950 --> 00:27:24.665 position:50% align:middle And, under these seven categories, there were 57 identified subcategories. 00:27:26.780 --> 00:27:32.630 position:50% align:middle Again, there was a high level of consistency in what was expected, with the main difficulty in comparing 00:27:32.630 --> 00:27:38.660 position:50% align:middle being the different levels of specificity provided in the different jurisdictions documentation. 00:27:38.660 --> 00:27:44.780 position:50% align:middle Some jurisdictions stated their requirements down to discrete tasks, while others used more generalized 00:27:44.780 --> 00:27:47.410 position:50% align:middle and higher-level descriptions. 00:27:47.410 --> 00:27:51.940 position:50% align:middle It was also difficult to determine the level of knowledge expected in any area, 00:27:51.940 --> 00:27:58.210 position:50% align:middle as the words and understanding or a basic level of knowledge for safe practice were often used in the 00:27:58.210 --> 00:28:00.175 position:50% align:middle description of the statement. 00:28:01.980 --> 00:28:08.080 position:50% align:middle So, the next area of Phase 2 that was investigated was the expected standards for professional 00:28:08.080 --> 00:28:10.290 position:50% align:middle practice and behavior. 00:28:10.290 --> 00:28:16.056 position:50% align:middle Five of the jurisdictions had updated their expectations within the last three years and all 00:28:16.056 --> 00:28:22.230 position:50% align:middle but one jurisdiction had standards that were less than 10-years-old, with that jurisdiction currently 00:28:22.230 --> 00:28:25.030 position:50% align:middle undertaking a review. 00:28:25.030 --> 00:28:31.630 position:50% align:middle Every jurisdiction also had additional practice or clinical standards and guidelines that relate 00:28:31.630 --> 00:28:34.420 position:50% align:middle to specific areas of practice. 00:28:34.420 --> 00:28:41.820 position:50% align:middle These standards or guidelines cover a wide range of topics from consent and privacy and confidentiality 00:28:41.820 --> 00:28:48.350 position:50% align:middle to expectations relating to areas as diverse as advanced care directives, diabetes, 00:28:48.350 --> 00:28:50.650 position:50% align:middle and vascular access. 00:28:50.650 --> 00:28:55.130 position:50% align:middle Across the nine jurisdictions, there were 69 of these more specific 00:28:55.130 --> 00:28:56.875 position:50% align:middle standards and guidelines. 00:28:58.450 --> 00:29:04.400 position:50% align:middle So, these are the categories and subsections used in the mapping framework for professional practice 00:29:04.400 --> 00:29:06.720 position:50% align:middle and behavioral standards. 00:29:06.720 --> 00:29:13.230 position:50% align:middle In total, there were 61 subcategories identified across these six main categories. 00:29:13.230 --> 00:29:18.010 position:50% align:middle Again, far too many to discuss in this presentation. 00:29:18.010 --> 00:29:22.640 position:50% align:middle But this is the level of consistency across the jurisdictions. 00:29:22.640 --> 00:29:29.750 position:50% align:middle While the level of consistency in this area is less than was found in the entry-to-practice expectations, 00:29:29.750 --> 00:29:32.697 position:50% align:middle it is still reasonably high at 73%. 00:29:32.697 --> 00:29:39.590 position:50% align:middle Three jurisdictions, Australia, New Zealand, and Ontario addressed all the subcategories in all the 00:29:39.590 --> 00:29:42.210 position:50% align:middle categories in the framework. 00:29:42.210 --> 00:29:48.410 position:50% align:middle And every jurisdiction addressed all the subcategories in the category "Works in collaboration and partnership 00:29:48.410 --> 00:29:51.740 position:50% align:middle with individuals, families, and communities." 00:29:51.740 --> 00:29:57.250 position:50% align:middle The gaps mostly occurred in two categories, "Promoting health" and "Demonstrating integrity and 00:29:57.250 --> 00:29:59.620 position:50% align:middle trust in the profession." 00:29:59.620 --> 00:30:04.630 position:50% align:middle In most cases where there was a gap, this only amounted to one sub-category 00:30:04.630 --> 00:30:05.771 position:50% align:middle within a category. 00:30:08.180 --> 00:30:13.410 position:50% align:middle The third area of review were the standards for educational program approval. 00:30:13.410 --> 00:30:18.060 position:50% align:middle And this was the most complex one to review and compare. 00:30:18.060 --> 00:30:23.810 position:50% align:middle Because all jurisdictions undertook multiple steps and processes in their program accreditation and 00:30:23.810 --> 00:30:29.650 position:50% align:middle approval process, a number of different areas were investigated and reviewed. 00:30:29.650 --> 00:30:34.410 position:50% align:middle There were often multiple organizations external to the regulator involved. 00:30:34.410 --> 00:30:40.600 position:50% align:middle These included accreditation and quality assurance organizations and government departments or agencies 00:30:40.600 --> 00:30:45.580 position:50% align:middle responsible for approving education or universities. 00:30:45.580 --> 00:30:52.690 position:50% align:middle The types of areas that were investigated in this area included the types of program approvals given, 00:30:52.690 --> 00:30:58.990 position:50% align:middle how the approval of the educational institution was obtained, requirements for monitoring and reporting, 00:30:58.990 --> 00:31:05.810 position:50% align:middle steps in the assessment process, standards used in the program approval process, 00:31:05.810 --> 00:31:11.030 position:50% align:middle clinical hours requirements, evidence required for demonstrating compliance, 00:31:11.030 --> 00:31:12.459 position:50% align:middle and outcomes measures. 00:31:13.950 --> 00:31:20.700 position:50% align:middle All jurisdictions basically followed a similar process with some differences noted in the evidence required 00:31:20.700 --> 00:31:25.712 position:50% align:middle for demonstrating compliance with the standards and the use of outcomes measures. 00:31:27.230 --> 00:31:33.440 position:50% align:middle So, these are the categories that were used in the mapping framework for standards for program approval. 00:31:33.440 --> 00:31:39.270 position:50% align:middle Under these seven categories, 35 subcategories were identified. 00:31:39.270 --> 00:31:45.030 position:50% align:middle And this is the level of consistency across the jurisdictions. 00:31:45.030 --> 00:31:51.936 position:50% align:middle As you can see, the level of consistency across the jurisdictions was very high, 94%. 00:31:51.936 --> 00:31:59.150 position:50% align:middle Four jurisdictions, Australia, Ireland, New Zealand, and the UK addressed all the subcategories 00:31:59.150 --> 00:32:00.200 position:50% align:middle in the mapping framework. 00:32:00.200 --> 00:32:08.680 position:50% align:middle The remaining jurisdictions exhibited only one gap in one subcategory of the framework. 00:32:08.680 --> 00:32:14.300 position:50% align:middle All jurisdictions demonstrated all the subcategories in an overview of program governance, 00:32:14.300 --> 00:32:19.060 position:50% align:middle program evaluation and quality assurance, curriculum and content, faculty, 00:32:19.060 --> 00:32:21.500 position:50% align:middle and resources for teaching and learning. 00:32:21.500 --> 00:32:26.420 position:50% align:middle Gaps were noted in the subcategories of student admission, progression, transfer, discontinuation, 00:32:26.420 --> 00:32:31.730 position:50% align:middle and completion, program leadership, and student experience and support. 00:32:31.730 --> 00:32:37.200 position:50% align:middle This review of the educational standards identified some consistent issues. 00:32:37.200 --> 00:32:41.690 position:50% align:middle These were in relation to the requirements for admission to a program, 00:32:41.690 --> 00:32:49.280 position:50% align:middle the extent and quality of sort of clinical learning experiences, the appropriate education and support 00:32:49.280 --> 00:32:53.430 position:50% align:middle available to nursing faculty, including clinical educators, 00:32:53.430 --> 00:32:58.560 position:50% align:middle and the need for appropriate support mechanisms to be in place for students. 00:32:58.560 --> 00:33:06.200 position:50% align:middle The comparison of clinical hours showed significant variation from no required minimum hours 00:33:06.200 --> 00:33:11.890 position:50% align:middle to 2,300 hours, which is the requirement for all the EU jurisdictions. 00:33:11.890 --> 00:33:17.970 position:50% align:middle So, using the minimum average hours in an approved program for jurisdictions who have no minimum hours 00:33:17.970 --> 00:33:23.450 position:50% align:middle requirement and the minimum number of hours required in the other jurisdictions, 00:33:23.450 --> 00:33:31.450 position:50% align:middle the range of clinical hours was 687 to 2,300, with the average number of clinical hours across the 00:33:31.450 --> 00:33:35.502 position:50% align:middle nine jurisdictions being 1,513. 00:33:35.502 --> 00:33:41.880 position:50% align:middle In reviewing the literature and in discussion with the jurisdictional representatives, 00:33:41.880 --> 00:33:48.750 position:50% align:middle it was identified that more work was needed to get a better understanding of the minimum hours requirements 00:33:48.750 --> 00:33:51.845 position:50% align:middle or if other indicators should be used in this area. 00:33:53.630 --> 00:33:58.860 position:50% align:middle So, undertaking this comparative mapping of the standards was challenging. 00:33:58.860 --> 00:34:04.540 position:50% align:middle The jurisdictional statements used different wordings and they all had different levels of detail included 00:34:04.540 --> 00:34:06.660 position:50% align:middle within their statements. 00:34:06.660 --> 00:34:14.210 position:50% align:middle Some jurisdictions were very high-level and generalized, while others use detail and often relating 00:34:14.210 --> 00:34:17.920 position:50% align:middle to specific knowledge and tasks. 00:34:17.920 --> 00:34:23.000 position:50% align:middle Sometimes all the steps associated with a particular event were in one statement, 00:34:23.000 --> 00:34:26.090 position:50% align:middle and at other times they would break them down into multiple statements. 00:34:26.090 --> 00:34:33.210 position:50% align:middle As a result, to complete this mapping exercises, the statements needed to be deemed substantially 00:34:33.210 --> 00:34:38.310 position:50% align:middle comparable or recognizably similar rather than identical. 00:34:38.310 --> 00:34:44.830 position:50% align:middle And in doing this, it raised the question what level of detail is necessary for statements 00:34:44.830 --> 00:34:48.340 position:50% align:middle to be considered consistent? 00:34:48.340 --> 00:34:52.820 position:50% align:middle So, this has now led us into Phase 3 of the project. 00:34:52.820 --> 00:34:59.840 position:50% align:middle Phase 3 is just beginning and will in detail examine the operational processes being used by each 00:34:59.840 --> 00:35:06.400 position:50% align:middle jurisdiction and how the different aspects of the requirements for licensure or registration are 00:35:06.400 --> 00:35:13.380 position:50% align:middle interpreted and operationalized in the actual licensure and registration process. 00:35:13.380 --> 00:35:20.190 position:50% align:middle This part of the process will also create a comprehensive description of the terms used by the 00:35:20.190 --> 00:35:23.880 position:50% align:middle different jurisdictions when they undertake their work. 00:35:23.880 --> 00:35:31.080 position:50% align:middle This phase will involve describing the process used to license or register a domestic applicant, 00:35:31.080 --> 00:35:36.640 position:50% align:middle it's hoping to identify the approximate number of cross-jurisdictional applicants, 00:35:36.640 --> 00:35:42.780 position:50% align:middle and then identify the similarities, issues, challenges, and difficulties that jurisdictions are currently 00:35:42.780 --> 00:35:49.740 position:50% align:middle encountering when licensing or registering an applicant from another INRC jurisdiction. 00:35:49.740 --> 00:35:54.740 position:50% align:middle Case studies of successful and unsuccessful international applicants will be used 00:35:54.740 --> 00:35:57.170 position:50% align:middle to identify these issues. 00:35:57.170 --> 00:36:00.000 position:50% align:middle And this work is proposed to be completed by late 2021. 00:36:02.700 --> 00:36:08.600 position:50% align:middle So, when Phase 3 is completed, this project will have produced a very thorough and 00:36:08.600 --> 00:36:14.580 position:50% align:middle detailed analysis of the current processes underpinning licensure or registration across all 00:36:14.580 --> 00:36:17.460 position:50% align:middle the participating jurisdictions. 00:36:17.460 --> 00:36:24.830 position:50% align:middle In essence, this will also capture the key components that represent current regulatory expectations for RN 00:36:24.830 --> 00:36:27.080 position:50% align:middle education and practice. 00:36:27.080 --> 00:36:34.290 position:50% align:middle To my knowledge, this comparison has not been undertaken before across this many jurisdictions. 00:36:34.290 --> 00:36:40.060 position:50% align:middle The immediate benefits of this work will be to improve the prospects for member jurisdictions 00:36:40.060 --> 00:36:45.620 position:50% align:middle to establish efficient, effective, and safe mobility between the jurisdictions, 00:36:45.620 --> 00:36:51.220 position:50% align:middle but there also are potentially other implications from this work, largely dependent on the imagination and the 00:36:51.220 --> 00:36:53.900 position:50% align:middle desires of the members. 00:36:53.900 --> 00:36:57.040 position:50% align:middle So, thank you, and I'm happy to take any questions. 00:37:18.000 --> 00:37:19.630 position:50% align:middle - [Host] Alison, thank you so much. 00:37:19.630 --> 00:37:26.240 position:50% align:middle That was quite interesting and really moves global regulation significantly forward. 00:37:26.240 --> 00:37:31.660 position:50% align:middle Is there anything else you would like to tell us about the next phase of this study and who you'd 00:37:31.660 --> 00:37:33.154 position:50% align:middle like to participate? 00:37:34.290 --> 00:37:40.680 position:50% align:middle - Well, the third phase of this study is where we're really looking at the detailed processes that the 00:37:40.680 --> 00:37:49.770 position:50% align:middle regulators do, how do you actually go about registering an applicant, from both the domestic applicants, 00:37:49.770 --> 00:37:54.880 position:50% align:middle and also the applicants that you receive from another INRC jurisdiction. 00:37:54.880 --> 00:38:00.120 position:50% align:middle So, it is really trying to get down into that detailed process of what is actually undertaken. 00:38:00.120 --> 00:38:07.700 position:50% align:middle And the purpose of this is so that everybody can understand what the other jurisdictions do and to kind 00:38:07.700 --> 00:38:15.200 position:50% align:middle of be able to gain more confidence in their processes and to understand where there may be difficulties or 00:38:15.200 --> 00:38:21.160 position:50% align:middle maybe challenges and how can we go about addressing those challenges and difficulties. 00:38:21.160 --> 00:38:27.080 position:50% align:middle So, we need to know what they are in order to know how to go forward with the next step. 00:38:27.080 --> 00:38:32.930 position:50% align:middle So, what we're asking is that we would really like the jurisdictions to try and provide us with as much 00:38:32.930 --> 00:38:40.260 position:50% align:middle information as they can about how you go about doing your registration processes. 00:38:40.260 --> 00:38:48.820 position:50% align:middle And that space is going to be based on each one of those sections that were in the original Phase 1 where 00:38:48.820 --> 00:38:54.470 position:50% align:middle we talked about identity, language proficiency, education, etc. 00:38:54.470 --> 00:38:56.480 position:50% align:middle So, all of those different sections. 00:38:56.480 --> 00:39:00.000 position:50% align:middle So, that's really what Phase 3 is about. 00:39:00.000 --> 00:39:02.060 position:50% align:middle - Thank you so much. 00:39:02.060 --> 00:39:05.840 position:50% align:middle And I have some questions from some of our attendees. 00:39:05.840 --> 00:39:12.710 position:50% align:middle The first one is about the NCLEX exam and looks ahead into the future. 00:39:12.710 --> 00:39:21.560 position:50% align:middle And she asks, "Will there be a required exam for licensure or registration that will be the same 00:39:21.560 --> 00:39:22.640 position:50% align:middle as the U.S. 00:39:22.640 --> 00:39:31.270 position:50% align:middle NCLEX or will there be any difference in the exam questions based on jurisdictional differences?" 00:39:31.270 --> 00:39:35.570 position:50% align:middle - Well, I guess I can't really answer that question because that's something that would have 00:39:35.570 --> 00:39:36.770 position:50% align:middle to be negotiated. 00:39:36.770 --> 00:39:42.500 position:50% align:middle However, I think we need to remember that the NCLEX is an exam of nursing knowledge, 00:39:42.500 --> 00:39:47.090 position:50% align:middle it's not an exam of jurisdictional differences. 00:39:47.090 --> 00:39:52.710 position:50% align:middle And I think this has been shown when the NCLEX has been implemented in Canada and, again, 00:39:52.710 --> 00:39:55.360 position:50% align:middle when it was implemented in Australia. 00:39:55.360 --> 00:40:01.270 position:50% align:middle And one of the issues that I know that both the Canadians and the Australians looked at was, 00:40:01.270 --> 00:40:07.690 position:50% align:middle "Were there things that were of concern in relation to the jurisdiction versus was it just 00:40:07.690 --> 00:40:11.990 position:50% align:middle about nursing knowledge, which is the same everywhere?" 00:40:11.990 --> 00:40:18.770 position:50% align:middle So, and I think the fact that it has been able to be implemented in both Canada and Australia shows that the 00:40:18.770 --> 00:40:25.390 position:50% align:middle exam is basically about nursing knowledge, not about what happens in a particular jurisdiction. 00:40:27.778 --> 00:40:28.910 position:50% align:middle - Thank you. 00:40:28.910 --> 00:40:34.120 position:50% align:middle There was another question quite similar to that, which I believe you answered, 00:40:34.120 --> 00:40:38.540 position:50% align:middle which is other plans to require graduates to take the NCLEX. 00:40:38.540 --> 00:40:40.960 position:50% align:middle I think you've covered that. 00:40:40.960 --> 00:40:47.320 position:50% align:middle I'm going to go on to another question, which is, "Are there plans to add more jurisdictions 00:40:47.320 --> 00:40:49.160 position:50% align:middle such as India? 00:40:49.160 --> 00:40:54.790 position:50% align:middle Would the same information be sought from a new jurisdiction?" 00:40:54.790 --> 00:40:56.710 position:50% align:middle - Okay. 00:40:56.710 --> 00:41:00.690 position:50% align:middle That would be a decision of the International Nurse Regulator Collaborative. 00:41:00.690 --> 00:41:05.750 position:50% align:middle So, that decision would, obviously, be there entirely up to them because that's the 00:41:05.750 --> 00:41:08.250 position:50% align:middle organization that is doing this. 00:41:08.250 --> 00:41:14.840 position:50% align:middle So, when this project was originally started, there were eight jurisdictions, 00:41:14.840 --> 00:41:17.870 position:50% align:middle and then one more jurisdiction joined. 00:41:17.870 --> 00:41:22.900 position:50% align:middle And when that happened, the same information that had been obtained from the 00:41:22.900 --> 00:41:26.900 position:50% align:middle eighth jurisdictions, the ninth jurisdiction became a part of that. 00:41:26.900 --> 00:41:29.980 position:50% align:middle But participation in this project is also voluntary. 00:41:29.980 --> 00:41:35.900 position:50% align:middle Not all the jurisdictions may choose to participate in the project at the same time. 00:41:35.900 --> 00:41:42.130 position:50% align:middle And, so, it is a mixture between them wanting to first join the INRC and the other members. 00:41:42.130 --> 00:41:48.030 position:50% align:middle And that would have to be a question that's better addressed by David Benton from NCSBN who's the 00:41:48.030 --> 00:41:55.630 position:50% align:middle representative or also whether or not that jurisdiction wanted to participate in this project. 00:41:55.630 --> 00:42:03.250 position:50% align:middle - Alison, one final very quick question, what was your most surprising finding? 00:42:03.250 --> 00:42:09.820 position:50% align:middle - I guess the most surprising finding was the fact that we were so [inaudible] that, 00:42:09.820 --> 00:42:16.110 position:50% align:middle despite the fact that jurisdictions think that they're different, they're really not very different at all. 00:42:16.110 --> 00:42:22.450 position:50% align:middle And I guess that the more I looked into it, the less differences I found. 00:42:22.450 --> 00:42:28.750 position:50% align:middle And I think we all believe that we're different, but we're really not very different. 00:42:30.800 --> 00:42:34.660 position:50% align:middle - And with that, we will end this discussion for today. 00:42:34.660 --> 00:42:37.410 position:50% align:middle Thank you again, Alison, very much. 00:42:37.410 --> 00:42:41.490 position:50% align:middle We so appreciate all the work you've been doing. 00:42:41.490 --> 00:42:44.080 position:50% align:middle Thanks to Alison for joining us today. 00:42:44.080 --> 00:42:48.553 position:50% align:middle We're going to pause for a quick break and we'll be back in 5 minutes.